Childhood pneumonia a public health challenge

Despite being the single largest cause of deaths of children below the age of 5 years, responses from the government of India’s health programmes to protect children from childhood pneumonia and diagnose early those who develop pneumonia and treat them, is far from satisfactory. Pneumonia vaccination is not included in the national immunization programme rolled out by the government of India through public healthcare services. Treatment guidelines are unclear to healthcare providers in India who come from a broad range of medical disciplines and unclear linkages of health programmes with those development programmes that reduce the risks for a child to develop pneumonia, such as tobacco control, housing, nutrition, environment or pollution control, among others, are key barriers.

Pneumonia vaccination is not available free of cost in the government hospitals as it is not a part of government’s free immunization programme, said senior Paediatrician Dr Santosh Rai, Vatsalya Clinic, Lucknow when we asked him about availability of WHO recommended vaccination to prevent children from pneumonia. There is a difference between healthcare services in private and public sector. The World Health Organization (WHO) guidelines classify pneumonia into three kinds: mild, moderate or severe. On a general note childhood pneumonia continues to remain a formidable challenge in rural India compared to urban parts.

Agree Dr Ajay Kumar, senior Paediatrician, Hope Mother and Child Care Centre, Lucknow: Pneumonia vaccination is not available in government hospitals however it is available in private healthcare services, such as the Hope Mother and Child Care Centre. Because vaccination against childhood pneumonia is very expensive it is beyond the reach of many people who want their children to be vaccinated but aren’t able to afford it. There is not much difference in treatment of childhood pneumonia in government or private healthcare service centres however he points out the quality of service in government hospitals that force people to turn towards private healthcare service providers and shell out lot of money. In most private hospitals and government healthcare centres that deal with paediatric cases managing childhood pneumonia as per the WHO guidelines is possible, said Dr Kumar.

There is a difference between treatment services in private and government healthcare centres, said Dr Nidhi Johri, senior Gynaecologist and Obstetrician, Hope Mother and Child Care Centre, Lucknow. In private hospitals treating doctors take full responsibility of the clinical management of their cases and this increases accountability, but in government hospitals it is the ‘umbrella treatment’ approach where different experts are available on different days or timings. In the rural parts of India pneumonia management as per the WHO guidelines might not be available but in most urban areas childhood pneumonia is managed as per the WHO guidelines, said Dr Johri.

At times, in government hospitals children with pneumonia are barely given antibiotic or bronchodilator injections which is not enough to manage childhood pneumonia, said Dr Ritu Garg, senior Gynaecologist and Obstetrician, Yash Hospital, Lucknow. Very few government hospitals adhere to the WHO guidelines for treatment of childhood pneumonia. Yash Hospital, a private healthcare centre, manages childhood pneumonia as per the WHO guidelines too.

Dr Garg points out another challenge in management of childhood pneumonia – diagnosing pneumonia correctly. She said: children often presents with symptoms that are common to three similar conditions, pneumonia being one of them. The other two conditions are: bronchitis (where inflammation of lungs takes place in children which causes light cough) and broncho-pneumonia. Children with broncho-asthma or asthma also presents with similar symptoms said Dr Garg and treating doctors should be competent to diagnose pneumonia or other conditions a child may be suffering from correctly.

The WHO recommended treatment and care services for pneumonia should be available for all children who need it regardless whether they can afford it or not.

Neeraj Mainali – CNS
(Translation: Bobby Ramakant, CNS)